Correlates of vaping among adolescents in Canada.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk. Data and methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours. Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping. Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

Looking back from 2020, how cannabis use and related behaviours changed in Canada.

BACKGROUND: The Canadian government legalized non-medical cannabis use by adults in October 2018 to minimize associated harms and redirect profits from criminals. In October 2019, a wider array of products, including edibles, was legalized, with entry into the legal market beginning in December. DATA AND METHODS: Three quarters (the first quarters of 2018 and 2019 and the fourth quarter of 2020) of the National Cannabis Survey were used to examine changes in cannabis use (overall use and daily or almost daily (DAD) use), consumption methods, products and sources. RESULTS: Cannabis use in the past three months was higher in late 2020 (20.0%) than in 2019 (17.5%) and 2018 (14.0%), and this was particularly the case among: females (for whom rates rose to equal male rates for the first time), adults aged 25 and older, and some provinces. Similarly, DAD use, at 7.9% also increased. Higher percentages of Canadians reported getting at least some of their cannabis from legal sources or growing it, and fewer were relying on friends and family or illegal sources in 2020. DISCUSSION: This study spans three years-from before legalization to about two years after. It provides a more complete picture of the law's impact on cannabis use and related behaviours, given the more established legal cannabis industry better equipped to compete with the black market on price, convenience and selection. Findings demonstrate that change is continuing, and, as before, some cautions and assurances remain. The impact of the COVID-19 pandemic on cannabis use continues to be difficult to measure. Monitoring remains important, given the ever-changing provincial retail landscapes; the introduction of new products; and the pressure by the industry to remove or adjust potency limits, and allow widespread delivery, farm-gate sales and cannabis lounges.

Association of Severe Trauma With Work and Earnings in a National Cohort in Canada.

Importance: Traumatic injury disproportionately affects adults of working age. The ability to work and earn income is a key patient-centered outcome. The association of severe injury with work and earnings appears to be unknown. Objective: To evaluate the association of severe traumatic injury with subsequent employment and earnings in long-term survivors. Design, Setting, and Participants: This is a retrospective, matched, national, population-based cohort study of adults who had employment and were hospitalized with severe traumatic injury in Canada between January 2008 and December 2010. All acute care hospitalizations for severe injury were included if they involved adults aged 30 to 61 years who were hospitalized with severe traumatic injury, working in the 2 years prior to injury, and alive through the third calendar year after their injury. Patients were matched with unexposed control participants based on age, sex, marital status, province of residence, rurality, baseline health characteristics, baseline earnings, self-employment status, union membership, and year of the index event. Data analysis occurred from March 2019 to December 2019. Main Outcomes and Measures: Changes in employment status and annual earnings, compared with unexposed control participants, were evaluated in the third calendar year after injury. Weighted multivariable probit regression was used to compare proportions of individuals working between those who survived trauma and control participants. The association of injury with mean yearly earnings was quantified using matched difference-in-difference, ordinary least-squares regression. Results: A total of 5167 adults (25.6% female; mean [SD] age, 47.3 [8.8] years) with severe injuries were matched with control participants who were unexposed (25.6% female; mean [SD] age, 47.3 [8.8] years). Three years after trauma, 79.3% of those who survived trauma were working, compared with 91.7% of control participants, a difference of -12.4 (95% CI, -13.5 to -11.4) percentage points. Three years after injury, patients with injuries experienced a mean loss of $9745 (95% CI, -$10 739 to -$8752) in earnings compared with control participants, representing a 19.0% difference in annual earnings. Those who remained employed 3 years after injury experienced a 10.8% loss of earnings compared with control participants (-$6043 [95% CI, -$7101 to -$4986]). Loss of work was proportionately higher in those with lower preinjury income (lowest tercile, -18.5% [95% CI, -20.8% to -16.2%]; middle tercile, -11.5% [95% CI, -13.2% to -9.9%]; highest tercile, -6.0% (95% CI, -7.8% to -4.3%]). Conclusions and Relevance: In this study, severe traumatic injury had a significant association with employment and earnings of adults of working age. Those with lower preinjury earnings experienced the greatest relative loss of employment and earnings.

What has changed since cannabis was legalized?

BACKGROUND: The Canadian government legalized non-medical cannabis use by adults in October 2018 in order to minimize associated harms and re-direct profits from criminals. DATA AND METHODS: Seven quarters of (NCS) data were combined into two groups: pre- and post-legalization periods - to examine changes in: cannabis use (overall, daily or almost daily (DAD)), source of product, driving after consumption and riding in a vehicle with a driver who had consumed. RESULTS: By 2019, overall cannabis use had increased (16.8% vs. 14.9%), particularly among: males, adults aged 25 and older, and in Newfoundland and Labrador, Nova Scotia, New Brunswick, and Alberta. DAD use, at 6.0%, remained stable, as did the prevalence of driving within 2 hours of consumption (13.2%). Riding in a vehicle with a driver who had used declined, overall (from 5.3% to 4.2%) and among: females, persons aged 25 and older, and in Newfoundland and Labrador, Ontario and Alberta. Where Canadians reported obtaining their cannabis also changed, with increasing percentages reporting getting some or all of their cannabis from legal sources, and fewer using illegal sources or relying on friends/family. Some provinces experienced more change than others. DISCUSSION: While too soon to observe the longer-term impacts associated with the Cannabis Act, early indications based on data collected in the months surrounding enactment suggests some cautions and also some assurances. Ongoing monitoring will be essential particularly given the 2.0 Act modifications and the ever-changing provincial retail and regulatory landscapes.

Analysis of trends in the prevalence of cannabis use and related metrics in Canada.

BACKGROUND: The Canadian federal government legalized non-medical cannabis use by adults in October 2018. Ongoing monitoring of the effects of the change is needed because uncertainty remains about the impact of the legislation on cannabis use behaviours and whether the impact will affect some more than others. DATA AND METHODS: Data from the Canadian Tobacco, Alcohol and Drugs Survey and the Canadian Tobacco Use Monitoring Survey were used to examine longer-term (historical) rates of use during 2004 to 2017. Five iterations of the National Cannabis Surveys (NCS) (2018-2019) were used to examine current use (overall, daily or almost daily (DAD), quantities, and types of products) in the months before and after legalization. RESULTS: From 2004 through 2017 cannabis use decreased among 15 to 17 year olds, remained stable for 18 to 24 year olds, and increased among adults aged 25 to 64. During 2018 and into 2019, rates of cannabis use increased overall from 14% to 18%; with statistically significant increases also for males generally (16% to 22%) and males aged 18 to 64. Rates of cannabis use remained largely stable for females (13%) and seniors (4%). In 2019, about 60% of consumers reported using one cannabis product; use of dried cannabis (flower/leaf) was the most common (84.2%). The average user consumed 27.5 grams of dried cannabis (flower/leaf) over three months; amounts consumed varied depending on use frequency (e.g. occasional users: 2.6 grams/3 months versus DAD users: 62.6 grams/3 months). DISCUSSION: Results highlight the importance of understanding pre-legalization behaviours as changes in use after legalization may have begun prior to the legislation. NCS allows for the early impacts of legalisation to be examined and provides a picture of not only changes in who is using but also what and how much.

Prevalence and correlates of non-medical only compared to self-defined medical and non-medical cannabis use, Canada, 2015.

BACKGROUND: The Canadian federal government has committed to legalizing non-medical cannabis use by adults in 2018. Medical use was legalized in 2001; however, not all people reporting medical use have medical authorization. To prepare for monitoring the effects of the policy change, a greater understanding of the prevalence of cannabis use and the characteristics of all cannabis users is needed. DATA AND METHODS: Data from the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) were used to estimate prevalence and examine reasons for medical use and factors associated with people who reported using cannabis Non-Medically Only (NMO), compared with people who reported Self-Defined Medical and Non-Medical use (SDMNM), including use of other drugs and the non-therapeutic use of psychoactive pharmaceuticals. RESULTS: In 2015, 9.5% of Canadians aged 15 and older reported NMO cannabis use, while another 2.8% reported SDMNM use. Half of Canadians reporting some self-defined medical use cited pain as the primary reason. Daily and near-daily use was significantly more common among SDMNM users (47.2%) than among individuals considered NMO users (26.4%). Past-year cannabis users of any type were more likely to be male and younger, to have used other illicit drugs and at least one of three classes of psychoactive pharmaceutical drugs non-therapeutically, and to be daily smokers or heavy drinkers. SDMNM cannabis use was more common among people reporting worse health (general and mental), use of psychoactive pharmaceuticals, and living in lower-income households. DISCUSSION: Because non-medical cannabis use is common to both user groups analyzed, many similarities were anticipated. Nevertheless, SDMNM users also had several unique characteristics consistent with use to address medical problems. However, because the CTADS does not collect information about whether the individual has received a health care practitioner's authorization to use cannabis for a medical purpose this analysis should not be interpreted as an evaluation of people who access cannabis through Health Canada's medical access program, the Access Cannabis for Medical Purposes Regulations (ACMPR).

Analysis of trends in the prevalence of cannabis use in Canada, 1985 to 2015.

BACKGROUND: The Canadian federal government has committed to legalize, regulate, and restrict non-medical cannabis use by adults in 2018. To prepare for monitoring the health, social and economic impacts of this policy change, a greater understanding of the long-term trends in the prevalence of cannabis use in Canada is needed. DATA AND METHODS: Nine national surveys of the household population collected information about cannabis use during the period from 1985 through 2015. These surveys are examined for comparability. The data are used to estimate past-year (current) cannabis use (total, and by sex and age). Based on the most comparable data, trends in use from 2004 through 2015 are estimated. RESULTS: From 1985 through 2015, past-year cannabis use increased overall. Analysis of comparable data from the Canadian Tobacco Use Monitoring Survey and the Canadian Tobacco, Alcohol and Drugs Survey for the 2004-to-2015 period suggests that use was stable among 15- to 17-year-old males, decreased among 15- to 17-year-old females and among 18- to 24-year-olds (both sexes), and increased among people aged 25 or older. DISCUSSION: According to data from national population surveys, since 2004, cannabis use was stable or decreased among youth, and rose among adults. Results highlight the importance of consistent monitoring of use in the pre-and post-legalization periods.

Prevalence and correlates of marijuana use in Canada, 2012.

Based on data from the 2012 Canadian Community Health Survey--Mental Health, past-year and lifetime marijuana use among the household population aged 15 or older in the 10 provinces was examined. In 2012, 42.5% of the population reported having ever used marijuana, and 12.2% reported use in the past year. At 33.3%, the prevalence of past-year marijuana use was higher among 18- to 24-year-olds than among other age groups (20.0% at ages 15 to 17, 15.6% at ages 25 to 44, 6.7% at ages 45 to 64, and 0.8% at age 65 or older). Past-year use was higher in British Columbia and Nova Scotia and lower in Saskatchewan, compared with the rest of Canada. While the overall percentage of people reporting past-year use in 2012 was unchanged from 2002, the percentage of males who had ever used marijuana rose from 47.0% to 49.4%; among females, the prevalence of lifetime use remained stable at 36%.

Prescription medication use by Canadians aged 6 to 79.

Based on data from the 2007 to 2009 and 2009 to 2011 Canadian Health Measures Survey, this article provides national information about prescription medication use among community-dwelling Canadians. An estimated 41% of 6- to 79-year-olds who lived in private households reported taking at least one prescription medication in the past two days (current use). Generally, prescription drug use was higher among females and among people in poorer health, and increased with age. Approximately 11% of 45- to 64-year-olds and 30% of seniors aged 65 to 79 took at least five prescription medications concurrently. For adults aged 25 to 79, the leading prescription medication classes were lipid-lowering agents, ACE-inhibitors, peptic-ulcer and acid-reducers, beta-blockers (men), other analgesics and anti-pyretics (men), anti-depressants (women) and thyroid medication (women). Among children and young adults aged 6 to 24, the leading prescription medications were for attention deficit and hyperactivity disorder (males), depression, and hormonal contraception (females).

Seroprevalence of hepatitis B and C virus infections: Results from the 2007 to 2009 and 2009 to 2011 Canadian Health Measures Survey.

BACKGROUND: Chronic hepatitis B (HBV) and C (HCV) virus infections can lead to liver failure, liver cancer, and death. In Canada, prevalence studies of HBV and HCV have been limited to regional and special populations. DATA AND METHODS: Data are from cycles 1 (2007 to 2009) and 2 (2009 to 2011) of the Canadian Health Measures. Socio-demographic, health and lifestyle information was obtained via a household questionnaire; blood samples collected at mobile examination centres were used to identify present and resolved HBV infections, vaccine-induced HBV immunity, and HCV infections. RESULTS: The seroprevalence of present HBV infection among the population aged 14 to 79 was 0.4%, representing an estimated 111,800 individuals. Another 4.2% had evidence of a previous HBV infection. Nearly 30% had vaccine-induced HBV immunity. The seroprevalence of HCV infection was 0.5%, representing an estimated 138,600. More than half of people with laboratory-confirmed HBV and 70% with laboratory-confirmed HCV were unaware of their infections. INTERPRETATION: This is the first Canadian study to report laboratory-confirmed seroprevalence of HBV and HCV infections based on a nationally representative household sample. Substantial percentages of younger Canadians have vaccine-induced HBV immunity.

Pre-conceptional folic acid supplement use according to maternal country of birth.

BACKGROUND: Supplementation with folic acid tablets in the pre-conceptional period reduces the risk of neural tube defects (NTD). In Canada, the risk of NTD may differ across certain ethnic groups. It is not known whether pre-conceptional folic acid supplement use varies according to a woman's country of birth or her duration of residency in Canada. METHODS: We included 6349 Canadian women who gave birth between January 2005 and December 2006, and who had participated in the nationally representative Maternity Experiences Survey. Reported use of a supplement containing folic acid in the three months prior to conception was evaluated in association with maternal place of birth, categorized by nine regions of the world. Odds ratios (OR) were adjusted for maternal age, gravidity, income, education level, gestational age at first prenatal care visit, and number of years living in Canada. RESULTS: Relative to a rate of 61% among Canadian-born mothers, the adjusted OR for pre-conceptional use of supplements containing folic acid was significantly lower among those who emigrated from the Caribbean and Latin America (OR 0.46; 95% confidence interval [CI] 0.31-0.70), Northern Africa and the Middle East (OR 0.33; 95% CI 0.20-0.57), and China and the South Pacific (OR 0.55; 95% CI 0.40-0.78). CONCLUSION: Certain groups of women who are immigrants to Canada take pre-conceptional folic acid supplements at rates much lower than Canadian-born women. Interventions aimed at increasing folic acid use might focus on these women, perhaps around their time of arrival in Canada.

Smokers' use of acute care hospitals--a prospective study.

BACKGROUND: Previous Canadian estimates of hospital use by smoking history have been derived by applying disease-specific "smoking-attributable fractions" to administrative data. For this analysis, health survey data were linked to hospitalization data at an individual level, permitting prospective measures of hospital use by smoking status and age. DATA AND METHODS: Data for 28,255 respondents (outside Quebec) to the 2000/2001 Canadian Community Health Survey (CCHS) were linked to the Hospital Person-Oriented Information Database. Days in hospital over four years were quantified for each respondent and examined in relation to smoking status in 2000/2001. Multiple logistic regression was used to examine the association between smoking and hospitalization, while controlling for confounders. RESULTS: During the four years after their CCHS interview, current daily smokers and former daily smokers who had quit in the past five years averaged more than twice as many days in hospital as did never-daily smokers. Altogether, excess hospital days for current and former smokers aged 45 to 74 numbered 7.1 million over four years, and accounted for 32% of all hospital days used by people in this age group.